Questions and Answers

;;:s. The f ollowi:n{l discussions all relate to preventive medicine. Those on tobacco and health (chosen from among many received) were referred to Alan Blum, MD, who hc:s written frequently on this subject.

Smoking Gutdelines for Hospitals

Q A recent COMMENTARY in THE JOURNAL (243:739-740. 1980) suggested that physii:;ians should be active in the prevention

of smoking-related problems. Are there specific guidelines for a

rational smoking policy for hospitals? For example, should smoking be allowed in palients' rooms? Should visitors be allowed to smoke? Your help would be appreciated.

W11..LLA.M H. KOSE.. MO Findlay. Ohio

A "60 Flee Fire at VA Hospital; Smoking Blamed" reads a headline. in the May 6, 1980, issue of the

Chicago Tribune. Unfortunately, such headlines are all too common.. It is essential to remember that in the hospital setting, smoking is as much a fire. problem as a health problem. According to the Joint Commission on Accredita-

. tion of Hospitals (JCAH)' smoking is responsible for approximately 60% of the estimated 1,500 annual report,ed hospital fires. (The next leading. cause, faulty electrical wiring, is responsible for 20%.) Moreover, fires present a greater dang~r- in health care facilities than in other environments 'because of the number of· incapacitated patients who_ are unable to escape.

Although the JCAH suggests that all hospitals adopt and enforce a strong set of smoking regulations, their publications on the subject (eg, 1980 Accreditation Manual for Hos-pita1s, p- 45) are almost entirely concerned with containing rather than preventing fires.- Only seven specific recommendations are made regarding smoking, such . as the· following: "Patients who are confined to bed should be discouraged from smoking," and "Ashtrays shall be noncombustible."*'

A review of the medicolegal aspects of hospital fires noted that "fire in a hospital . is one of those potential disasters about . which the hospital is obliged to be constantly. on guard."' F~ilure to adhere to "reasonable standards,". as a result of which a: patient is burned in a fire for which he was not responsible, probably · would make the hospital liable without further ·proof of negli­gence.

If a bospital prohibits smoking in all but a.few specially designated areas, it should advise its insurance companies, so that fire insurance premiums can be lowered accord­ingly.

Bolstered by the increasing evidence of the adverse effects of secondhand smoke, a few hospitals, eg, Central Middlesex Hospital, London (Post{lrad Med J 49:682-683,

*The JCAH welwmes discuss-ion on this issue. Address correspondence to Helen Johnston, MD, Joint Commissi07l for Accreditation of Hos-pitals, 875 N Michigan Ave, Chicago, IL 60611.-ED.

€very Mttter must con1ain the writer·a name and addr~.u . bt..t1 ~ w;n be omitted on request. &Jbmitted queat.OOs •re pobli&h&d •• space permits and at the di.scretion of the editor. Alt inqu=ries. rec&ive a di.feet ma il _re,ply.

i

JAMA, July 11 , 1980-Vol 244, No. 2

' 1973), and several US hospitals, have established no­smoking wards and have tried to encourage more exem­plary educational roles for health professionals. The overriding principle in the newer policies is that nonsmok­ing .should be the rule in all public areas of the hospital unless otherwise specifically indicated.'·• The following guidelines patterned after those proposed by the Public Citizen's Health Research Group5 could serve as a model: Ban the sale of cigarettes, cigars, and pipe· tobacco in hospitals and on hospital grounds. Ask all patients before admission about their preference for a smoke-free ward and guarantee that preferen·ce. Ban smoking from ~1.1 corridors and elevators. Restrict smoking of tobacco in the hospital to specifically designated rooms. Require the hospital to put its smoking policy in writing and send to all employees and prospective employees.

Administrators and chiefs of staff can develop positive incentives for the perpetuation of such a policy. These can include the posting of nonthreatening. signs at all entrances and in corridors, as well as publishing the policy throughout the community at large. Enforcement should be assumed equally by administration, health profession­als, and employees, the underlying philosophy being that a hospital is not just another place of work, but, rather, a

,,place dedicated to health . Above all, a strong nonsmoking policy in hospitals can

add significantly to cost containment. More and more companies have . found that even after doling out cash bonuses to those employees who choose not to smoke,- an overall ·saving is-created by lowered levels of absenteeism; sick leave,- and medJcal-insurance premiwns.

k.A.M Bu .... lt.&O Morrie Fishbein FeHow. Hn9•1980 ·

1. JCAH Fire Safety Requirements Explained. Penpecti1Je8 Qn Accredi­tation, March-April, 1980. Chicago, Joint Commission on Accreditation of Hospitals. . .

2. Holder AR: Hospital fires.·JAMA 231:281-282, 1975. 3. Ball K, Stevenson A; Hospital action on smoking. Br Med J 2:Tn-778,

1979. 4. Brosseau BLP: Hospitals must stop pushing tobacco. Dim.e,u Healilt

Serv 54:5, 1977. 5. Fishman. L: More rights for airline passengers than for hospital

patients: A report on smokmg policies in metropolitan Wasmngton, DC, hospitals. Hosp.Admin Cun- 21:24, 1977.

'Single-Day' Treatment for Smoking :Cessation

Q Dr Neil Solomon. in a syndicated newspaper column, wrote · that he inlects a solution of vitamins, ·minerals, and· procaine

on each ear and alongside the nose o! -patients who want to stop smoking. He claims that the effect is immediate after four injections

of this soiution. What is your opinion about this so-called single-day treatment for smoking cessation? Is there any proo.f that it works?

Ew!RY A. CLOTHIER, MD Scotta<lale. Ariz

Among others inquiring about this treatment were Thomes P. Kennerly, MD, Houston; Jim J. Chow, MD, Manistique, Mich; and

J. C. Mowrer, Jr, MD, Rochester, NY.

A In 1979 the Internal Revenue Service (IRS) denied . an individual the right to deduct the cost of a:

smoking-cessation course-a correct. ruling but for the wrong reason. The IRS did not note (and .may not have known) that no single method of smoking cessation has an especially high or long-lasting success rate. (Most. methods show less than a 25% success rate after six months.) Rather, the tax collectors did not want to define

Questions and Answers 191